Many practices participate with programs or schools that provide training for students that are in the process of becoming healthcare professionals. This can range from residents, interns, nurses, medical and dental assistants to numerous other titles that will eventually result in an official or graduated title in the healthcare field. Many programs require a certain number of hours to be completed in job shadowing or clinical field observations.
Some practices also provide an opportunity for non-healthcare students (i.e., not being registered in an official healthcare training program) to come in and observe what happens in a practice to see if they would like to pursue a healthcare profession. Quite often, this type of observer is a late middle or high school student. Making general observations would involve watching staff activities without direct patient involvement (i.e., not being in exam or treatment rooms or other areas where patient treatment and conversations are occurring).
This may involve direct or indirect exposure to patient information (PHI) (verbal, printed, or electronic) and possibly direct diagnosis and treatment of a patient.
Note that the Privacy Rule allows a Covered Entity (such as a practice and its providers) to use or disclose PHI, without patient authorization if the use or disclosure is for the purpose of treatment, payment, or healthcare operations. The Privacy Rule defines healthcare operations, and includes “conducting training programs in which students, trainees, or practitioners in areas of healthcare learn under supervision to practice or improve their skills as healthcare providers, training as non-healthcare professionals, accreditation, certification, licensing, or credentialing activities.”
Additionally, professional students are also defined as a member of the practice’s workforce. Workforce members include employees, volunteers, trainees, and other persons whose conduct is under the direct control of a Covered Entity, whether or not they are paid by the Covered Entity. We do recommend having professional students sign a visitor confidentiality agreement. Because they are considered workforce members, they would also need to receive your new hire HIPAA training.
Because general students are not considered to be a member of the practice’s workforce and they are not enrolled in an official healthcare training program, they would not qualify as a professional student conducting job shadowing. Note that the general student could not be considered a Business Associate of the practice because they are not providing a service for the practice and do not fit the Privacy Rule’s definition of a Business Associate. If a general student were to be exposed to PHI and/or involved in direct diagnosis and treatment of a patient, the practice would need a signed authorization from each patient that the general student would have involvement with during their observation.
The practice should make it a policy to explain to patients who the student is (professional or general), the purpose of their involvement, and ask the patient if there are any objections. The student should leave the room if the patient objects to the involvement.